key: cord-0027836-ccurirna authors: Gruber-Baldini, Ann L.; Quinn, Charlene C.; Roggio, Anthony X.; Browne, Brian J.; Magaziner, Jay S. title: Telemedicine for Older Adult Nursing Home Residents to Avoid Emergency Department Visits: The Experience of the NHTeleED Project in Maryland date: 2022-02-26 journal: J Am Med Dir Assoc DOI: 10.1016/j.jamda.2022.01.061 sha: dba7557b16a25d3722244b6b386999143d58938d doc_id: 27836 cord_uid: ccurirna nan When a change in resident condition was identified by clinical staff, the resident was evaluated by staff on duty to determine whether the condition might warrant an ED visit, was potentially life-threatening, could be handled by internal nursing staff or delayed contact with a physician, or could be assessed by a telemedicine visit. Those determined to be life-threatening were sent immediately to the ED. If the condition was thought to be manageable within the facility or with a delayed contact with a physician without need for ED or telemedicine, residents were treated as needed by facility staff. Also, if the resident had an order refusing cardiopulmonary resuscitation and other life-sustaining treatments, no telemedicine visit or ED transfer was considered. Otherwise, a telemedicine visit was triggered and ED physicians, available 24/7, were contacted. A telemedicine cart was moved to the resident's room/bedside. The ED physician had access to the resident's SNF medical record during the telemedicine visit. Digital telescopes were available on the cart along with a computer screen for 2-way observation. Before initiating the telemedicine visits, residents were asked if they agreed to the visit. Bi-weekly meetings of clinical and research teams included reporting potential and completed telemedicine visits. Data were reported monthly by each participating SNF from June 2017 to August 2018 (Table 1) . A change in resident condition that warranted further evaluation was identified in 466 residents. Of those, 144 (31%) were identified for potential telemedicine visits. Of these 144, 61 (42%) had telemedicine visits and 83 (58%) did not for reasons related to staff inexperience or discomfort with using equipment, unavailability of telemedicine, or the availability of a nursing home onsite physician. The telemedicine visit allowed 68.9% (n ¼ 42 of 61) of the evaluated residents to remain at the SNF for treatment. Physicians' anecdotes (reported by the lead ED physician) suggested that when residents were transferred to the ED, physicians felt better prepared when they arrived because information had been provided from the telemedicine visit. After each telemedicine visit, SNF nurses and ED physicians completed satisfaction measures through an online portal (n ¼ 50 nurses and 45 physicians across the 61 telemedicine visits). Both groups agreed that patients were satisfied with the visit (6.0 on 7point scale); overall satisfaction with the telemedicine visit was similar for nurses (5.8) and physicians (5.6) . This demonstration provides evidence that telemedicine visits can be implemented and benefited SNF residents by allowing them to remain in place for treatment, limiting exposure to transport, exposure to infectious agents, and additional tests in the ED. The service provided acute-level care, 24/7 physician access, reduced frequency of calls to physicians, and facilitated timely care coordination. Limitations included frequent changes in nursing staff trained on a telemedicine visit, equipment challenges at the time of a consultation, and data not available to indicate whether important conditions were missed. There was also one facility (Facility C) that had large times (more than 8 months of the 15month reporting period) when the telemedicine visit was not being used because of structural and staffing issues. It is important to note that 58% of potential visits did not result in a telemedicine consultation. With the post-pandemic changes in Medicare and Medicaid reimbursement for telemedicine SNF visits, telemedicine may improve access and quality of care for SNF residents. 7, 8 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 Rapid changes in the provision of rehabilitation care in post-acute and long-term care settings during the COVID-19 pandemic Standards for the use of telemedicine for evaluation and management of resident change of condition in the nursing home Telemedicine and telehealth in nursing homes: an integrative review Reducing emergency department transfers from skilled nursing facilities through an emergency physician telemedicine service The nuts and bolts of utilizing telemedicine in nursing homes: the GeriCare@North Experience Pressure ulcer multidisciplinary teams via telemedicine: a pragmatic cluster randomized stepped wedge trial in long term care COVID-19 collaborative model for an academic hospital and long-term care facilities Long-term care nursing homes telehealth and telemedicine tool kit We thank Carolyn Frenkil for her continued encouragement, and the staff and patients of Future Care for their participation.